What's next after health law deadline?

THE WASHINGTON POSTApril 1, 2014 

After six long months of enrollment for insurance under the Affordable Care Act, Monday was the final day - sort of - to sign up for health insurance this year. Enrollment turned out better than many expected after HealthCare.gov stumbled badly out of the gate, but the overall number doesn't tell the full story of the health law's first enrollment period. It will take more time to assess the first-year performance, but here's what we know now.

Who's actually signed up?

We don't have the full data yet, but we have some basic numbers. The Obama administration said more than 6 million people and counting have signed up for private plans in the health insurance exchanges, or marketplaces, since Oct. 1. More than 8.9 million have been determined eligible for Medicaid (that includes people re-enrolling and previously eligible), and more than 3 million young adults have stayed on their parents' health plans during that time.

Six million exchange sign-ups - so, the administration hit its goal?

Not exactly. For starters, the administration says it never set a specific goal, though it did previously adopt the Congressional Budget Office's earlier estimate that 7 million would enroll in exchanges in 2014. The CBO later revised the estimate down to 6 million after technical problems hindered the first two months of enrollment.

Has the uninsured rate dropped?

It appears so, but we don't know by how much yet. We have a general sense of how many people have newly enrolled in Medicaid or stayed on their parents' health plans, but we don't know how many of those signing up through the exchanges, or off them, were previously uninsured.

Is the federal website working now?

The federal government's website had been running pretty smoothly since early December, but it ran into trouble Monday, when it was knocked offline for several hours. Aside from this late-hour stumble, HealthCare.gov had held up through some heavy traffic in the final weeks of enrollment, including 8.7 million visits in just the past week.

I don't have insurance yet but want it. What do I do?

Monday was the last day to sign up for coverage through HealthCare.gov, by phone at 800-318-2596, or through an insurer, broker or enrollment aide. If you had problems signing up Monday, the Obama administration will allow some more time to enroll. If you live in a state with a federal-run exchange, you can go to HealthCare.gov and "attest" that you had problems signing up before March 31. The administration hasn't said, however, how long it will keep this option available.

If you live in a state that's running its own exchange, the leeway policy may be different. For example, the District of Columbia's exchange is keeping enrollment open until April 15 for those who say they had trouble signing up earlier.

So, was enrollment really over Monday?

Not exactly. There are special enrollment periods for certain hardships or a change in circumstances such as the birth of a child or losing your job. Also, enrollment in Medicaid and the small-business exchanges, or SHOP, is open year-round. Regular enrollment isn't scheduled to start again until Nov. 15.

If I don't have insurance, will I get penalized?

You could, but not necessarily. The penalty per person this year is $95 or 1 percent of income, whichever is higher. However, there are exemptions to the mandate for people who earn too little, would struggle to afford insurance or have other reasons. The administration has spelled out 14 hardship exemptions in all. The penalty won't be assessed until you file your taxes next year, but the Obama administration isn't expected to enforce the mandate all that strongly.

What does this all mean for my insurance rates next year?

They're going up just as they do every year. It's not clear yet, though, by how much. Insurers will start filing 2015 rates in just a couple of months, and rate increases will depend on a number of factors. Insurers will be working with just a few months of claims from this year, so 2015 rates could also depend on how accurate insurers' predictions this year turned out to be.

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